Tuesday, August 16, 2011

This is my third installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” In our previous two pieces, Dr Ghaemi indicated he is no fan of normal, at least not in crisis situations that call for individuals (such as Churchill) with at least some practical experience in crazy

In my second installment - Normal: It Ain’t What It’s Cracked Up to Be - I mentioned a study reported by Dr Ghaemi that found that so-called mentally healthy individuals suffered a bad case of average-itis. These well-adjusted individuals tended to fit in rather than rock the boat. Not that there’s anything wrong with that. It’s just that, in a crunch, you don’t send in a normal person to do a crazy man’s job.

So far, so good. But in our first installment - The Normal Paradox - I also outlined an extremely contentious proposition advanced by Dr Ghaemi, one having to do with “normal” as a strong contributing factor to Nixon and George W Bush making bad decisions. In other words, humans are perfectly capable of exercising appalling judgment on their own account, with no assist from any condition with a DSM pedigree.

But Nixon had to have been crazy, you may well counter. Indeed, maybe he was. But the point is that he didn’t have to be, and neither does anyone else. Normal people have committed the worst atrocities imaginable. Enter Ghaemi’s next case study, Adolph Hitler.

First the black box warning: Reconceptualizing Hitler is bound to raise intense reactions. I totally respect that. I’m not even asking you to keep an open mind.

Way way back, on mcmanweb, I reviewed Hershman and Lieb’s “Brotherhood of Tyrants,” which attributed Hitler’s atrocities to bipolar. No, I said in effect. True, the evidence for Hitler’s bipolar is compelling, but not everyone with a mood disorder invades Poland. It had to have been sociopathy.

Not really, says Dr Ghaemi. We start with impossible-to-ignore documentation of Hitler’s depressions and (hypo)manias, but until 1937, Ghaemi contends, Hitler’s condition “seemed manageable.” That changed when he started to take amphetamines.

In 1937, Hitler began treatment with a new personal physician, Theodor Morell, who stayed on till nearly the end. Dr Morell prescribed amphetamines for depression (and a narcotic and other drugs for GI problems and barbiturates for sleep). Confidantes such as Hess and Himmler immediately noted the change in their boss’ behavior. In 1941, there is evidence Hitler was taking amphetamines intravenously on a daily basis, supplemented by oral doses. By 1943, he was receiving multiple daily injections.

Dr Ghaemi points out that oral amphetamines cause mania in about half of individuals with bipolar, with a much greater certainty with intravenous injections. Rats are deliberately injected with amphetamines to produce an animal model of psychosis. As thoroughly odious has Hitler had been, Ghaemi observes, citing Bullock, he was a realistic and astute politician. Moreover, he hadn’t invaded any countries, nor had he turned genocidal. As Ghaemi describes it: “Morell lit a fuse that exploded the entire world.”

Thus, up to 1937, Hitler’s bipolar benefited him in a way that influenced his rise to power, “fueling his charisma, his resilience, and political creativity.”

Ghaemi acknowledges that Hitler had always been an angry man, but that he had generally been “courteous and proper” in social settings. By 1942 (after the war had turned against him) Hitler was routinely screaming at his generals. Whereas he used to have no trouble delegating authority, now he became obsessed with details. His doctor only made things worse by intensifying the quack treatments.

Okay, so how do we account for Nazism in the first place? Or, for that matter, any evil? What about Hitler’s henchmen? How sick were they?

After the War, Ghaemi tells us, the Allies put two dozen high-ranking Nazis (including Goering and Ribbentrop) through extensive psychiatric evaluation and psychological testing, which went on for two years. The evaluations revealed that these men were normal. Goering, for instance, according to one investigator, had a “normal basic personality,” though “he was cynical and filled with mystical fatalism.”

Hitler’s criminals went to their deaths, totally impenitent, very pleasant people to talk to, righteous to the end.

Are we ever going to understand evil? Probably not. Are we making a serious mistake always associating evil with crazy? Definitely so. Evil, unspeakable evil, lurks everywhere. Crazy is not a requirement. Normal works very well with evil. Until we come to terms with this shocking fact of life, evil will continue to flourish, barely contested. That’s been our long past. Our futures may turn out short.

11 comments:

gina
said...

John wrote: "...one having to do with “normal” as a strong contributing factor to Nixon and George W Bush making bad decisions. In other words, humans are perfectly capable of exercising appalling judgment on their own account, with no assist from any condition with a DSM pedigree."

Oh, but I beg to disagree. Dubya would be at home at **many** points in the DSM. I cannot imagine that not being obvious to any professional. Check out "Bush on the Couch."

John -- it seems to me that all sociopathic leaders (Stalin, Idi Amin, etc.) started out somewhat "normally" and often charismatic.

And what kind of metrics were they using to gauge "normal" back then? If you weren't yelling gibberish and frothing at the mouth, you were probably normal. If you could think rationally, do math problems, etc. you were probably normal.

An interesting documentary we watched the other night (more like a college lecture) posed the idea that the Nazis and the German people (including most of the populace, prominent philosophers and even several Nobel Prize-winning physicists) were aligned in a certain philosophy, largely based on Nietzsche.

According to Hicks, the Nazis weren't "evil" or "crazy." But they did buy into this philosophy that promised to move mankind forward -- even save mankind from the sappy, stultifying "slave" mentality and propel them into the "master" role.

They felt they were acting nobly and with purpose. And they primed the pump with years of nationalistic narcissistic supply, starting with the schoolchildren.

As for Hitler's amphetamine usage, that is what the Norwegian terrorist used to steel himself for his mission, to obliterate empathy.

Anyway, I just don't find Ghaemi that astute of a thinker; he makes many flawed assumptions, IMHO, and shows his ignorance of history.

Hey, Gina. Your comments are why I love doing blogs. Hitler didn't have the forces to start a war till 1939, so he wasn't about to start one earlier. But his declaring war on the US in 1941 was the act of a madman. He did it after Pearl Harbor with consulting anyone. The US had only declared war on Japan. Ghaemi doesn't mention this and you can argue it a zillion ways. Interesting about "normal." is there a theory about high-functioning sociopaths? Certainly Germany subscribed to it's delusional Wagnerian myths. Then we have our myth of American exceptionalism which may prove one day equally disastrous. National madness - no nation is immune. Evil thrives in these conditions.

I have no answers. But I'm sure as he'll glad you're asking questions.

Couldn't a person be a sociopath and have bipolar? There was also a theory that Hitler had Parkinsons--sorry I cant remember where I saw it, I think a program on Discover. This would also account for physical and mental deterioration.

Actually, I think his ultimate crazy moment was when he invaded Russia. There was ample historical evidence to prove that didn't work.(Napoleon). The US, at that time had a booming isolationist movement and an outsider could easily conclude that we could not prepare quickly for war on two fronts.When I see the films of the era, I don't see any charisma, I just see evil, and mob mentality. I don't know if that is because I know what happened or if I'm picking up on something. On the other hand, Churchill was warning about Hitler well ahead of time. I think crazy can be evil, I think normal can be evil. I think mob mentality is part of the definition of evil.

And the current state of US politics is worrisome. Given the Republican winner in Iowa, John you might want to rethink about crazy being useful for a leader.

Hey, Lizabeth. Oh yes - a person with bipolar can also be a sociopath. I still go with Hitler as bipolar and a sociopath, but I can appreciate the case Ghaemi makes against this. Invading Russia was definitely mad, especially with winter coming on. But Hitler almost succeeded thanks to another mad (bipolar plus sociopath/narcissist) leader in Stalin. The two of them kept making one bonehead move after the other (Stalin had purged virtually his entire officer corps just years before).

Re Republican tea-baggers - I'm still trying to figure out collective madness. I dealt with this back in the 80s as a financial journalist writing about investment bubbles in Australia. Thanks for bringing this up - I need to be blogging on this.

I'd never heard the amphetamine hypothesis to explain Hitler's decision to start invading. It makes a lot of sense, considering that he'd been quite effective at advancing his agenda in the beginning.

Invading Poland is pretty easy; as Dave Barry said, all that's required is for the Germans to forget to set their parking break. Invading Russia, on the other hand, is clearly delusional.

I'd always assumed his actions were attributable to a personality disorder exacerbated by a brutally abusive upbringing, and further exacerbated by a sort of "Tom Cruise effect" -- that by 1939, nobody was left to tell him he was acting irrationally. For that matter, the people around him had their own issues (in Ken Brannagh's "The Goebbels Diaries", Goebbels adult writings seem more like those of a maladjusted adolescent).

In any event, the amphetamine hypothesis has far more explanatory value than an article I read in college, which attempted to reconstruct Hitler's toilet training and blame everything on that (I wish I were joking ...).